Yes, you can be in menopause and still have PCOS.

Unfortunately, PCOS does not go away once a woman enters menopause. Age-related PCOS changes were once considered a “medical black hole;” PCOS was unstudied prior to the last decade. It is argued that upon menopause, when a woman is no longer ovulating, PCOS no longer exists.

According to the American Association of Clinical Endocrinologists Practice Guidelines, diagnostic criteria for women with PCOS after menopause does not exist. However, the limited research on PCOS in the aging woman shows changes that both improve her symptoms of PCOS and decrease her risk for chronic disease. PCOS is now known to have numerous metabolic risks that start early in adulthood and persist throughout a woman’s lifespan.

This article discusses PCOS and its associated risk factors, how PCOS changes with age, and effective evidence-based treatment options in menopause.

Reproductive Changes

Numerous studies have found that testosterone levels in women with PCOS gradually decrease to normal-for-age levels, but that this decrease was slower than for women without PCOS. 

Levels of DHEA, the precursor to testosterone, remained higher after menopause in those with PCOS. This evidence shows that women with PCOS reach menopause perhaps 2 years later than do women without PCOS, due to higher and prolonged androgen levels.

Decreases in androgens have been shown to improve menstrual regularity, perhaps increasing the chances of conception in some women who struggled with infertility for years. In addition, hirsutism symptoms have been shown to persist or worsen after menopause, possibly from lifelong exposure to high androgen levels.

PCOS and Menopause: New Research Findings

Anti-Mullierian Hormone (AMH) is a marker of ovarian reserve. AMH levels have been shown to remain significantly elevated in older women with PCOS, which may be a more reliable diagnostic criterion for the condition than testosterone is, since AMH levels naturally decrease with age.

Metabolic Changes with Age

It is now known that PCOS is a lifelong disease, although its manifestation changes as a woman approaches menopause.  Weight and metabolic changes tend to worsen with age. Women with PCOS are at higher risk for metabolic diseases post-menopause than are their age-matched peers. Additionally, the presence of PCOS increases the risk for endometrial cancer.

Up to 40% of women with PCOS will develop IGT or T2DM by the fourth decade of life. 

Compared to age- and weight-matched women, those with PCOS have a fivefold increased risk for T2DM over an eight-year period^. There is a rapid progression of IGT to T2DM when PCOS is present. For this reason, the  have recommend annual screening for women with PCOS who have IGT, utilizing an oral glucose tolerance test (OGTT). AE-PCOS also recommends that all women with PCOS and normal glucose levels receive OGTT screening every two years.

Despite the associated risk factors for CVD among women with PCOS, evidence of CVD in this population is conflicting. Causes may include the large heterogeneity existing among members of this population, as well as a lack of studies.

Other Age-Related Changes: PCOS and Menopause

A 2017 meta-analysis suggests that when PCOS is present, stroke risk increases by 36% but the risk for all-cause mortality does not increase. The reason for increased stroke risk is unknown but the authors suggest that practitioners “aggressively screen patients with PCOS for stroke risk factors and initiate treatments.”

Bone Density

Studies on bone mineral density (BMD) and fractures in postmenopausal women with PCOS are lacking. Androgens are important for bone mass and may be protective against fractures and bone loss. Fracture rates were decreased in a large population of women with PCOS living in Denmark. More importantly, this study found that: Fracture risk reduction was the same regardless of testosterone levels (high versus normal)

Nutrition Management for PCOS and Menopause

Diet and lifestyle changes involving regular exercise, adequate sleep quality, smoking cessation, and stress reduction are recommended as the first-line approach to treating PCOS after menopause.

Antioxidants Matter

Compared to women without PCOS, those with PCOS have higher levels of oxidative stress, insulin, and inflammatory markers.

Low levels of both magnesium and zinc have been found in women with PCOS. Magnesium and zinc are antioxidants that help to prevent oxidative damage and inflammation, and they also play a role in insulin regulation. For women with PCOS, supplementing with zinc and magnesium has improved their biomarkers of inflammation and oxidative stress, as well as their hormonal profiles.

Researchers have investigated the use of an anti-inflammatory diets in women with PCOS including the DASH Diet with favorable results in reducing levels of inflammatory markers cholesterol, blood pressure, and fasting blood glucose

These results show that women with PCOS benefit from diets high in fiber (both soluble and insoluble) as well as antioxidant-rich whole foods such as:

• cold-water fish
• nuts
• avocados
• whole grains
• beans
• legumes
• fruits
• vegetables
• green tea

Nutrition Supplements for PCOS

Some nutrition supplements, such as berberine, resveratrol, myo and d-chiro inositol and the antioxidant n-acetylcysteine (NAC), have been shown to improve metabolic aspects of PCOS, working as well as if not better than metformin. Other supplements shown to improve aspects of PCOS include vitamin D, zinc, magnesium, and omega-3 fatty acids.

Resveratrol may help to reduce inflammation and androgens, and improve insulin sensitivity and cholesterol and support heart health.* Resveratrol Protect contains the polyphenol resveratrol, which is found in peanuts, berries, red grape skins, and red wine and quercertin, a flavonoid found in red onions, apples, olive oil, dark berries and herbs that provides anti-inflammatory benefits and is believed to protect cells from the aging process.*

Vitamin B12 deficiency is a concern for older individuals. Long-term metformin use has been shown to reduce levels of vitamin B12. Women with PCOS who take metformin must have their vitamin B12 levels checked annually and supplement their diets with vitamin B12 if needed.

Conclusion

PCOS is a lifelong condition with serious long-term health risks. The nutrition management for older women with PCOS should take into account the risk of long-term complications associated with this disease. Effective and aggressive treatment is needed, with interventions involving diet, nutritional supplements, lifestyle, and insulin sensitizers for older women with PCOS who have metabolic complications.

Angela Grassi, MS, RDN, LDN, is the founder of The PCOS Nutrition Center, for which she provides evidence-based nutrition information and coaching to women with PCOS. Angela is the author of several books on PCOS, including PCOS: The Dietitian’s Guide, The PCOS Workbook: Your Guide to Complete Physical and Emotional Health, and The PCOS Nutrition Center Cookbook. Angela is the past recipient of The Outstanding Nutrition Entrepreneur Award, The Award in Excellence in Practice in Women’s Health, and The Award for Excellence in Graduate Research, from the Academy of Nutrition and Dietetics. Having PCOS herself, Angela has been dedicated to advocacy, education, and research of the syndrome. Click below to schedule a session with Angela to learn more about how nutrition coaching for PCOS can help you!

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